Aim of the present study was to present a case of eccentric posterior lamellar disc (PLD) trephination as surgical complication of Femtosecond laser supported Descemet stripping automated endothelial keratoplasty (F-DSAEK) documented by anterior segment optical coherence tomography (AS-OCT). Two days postoperatively a suspected partial detachment of the graft, visible at the slit-lamp as a peripheral thickened edge involving one quadrant was noted. AS-OCT showed that a full-thickness corneal arc due to eccentric trephination was responsible for the incomplete peripheral adhesion of the PLD. Repeated air injections in the anterior chamber did not favour the adhesion of the graft. AS-OCT and clinical follow-up documented a progressive spontaneous adhesion of the peripheral full-thickness corneal graft edge. This case demonstrates that centration of the trephination in F-DSAEK is crucial and a complete graft attachment can occur without surgical intervention.